Laboratory evaluation for children with chronic abdominal pain and alarm findings

Laboratory test	Laboratory finding	Potential significance
Stool for occult blood (if not already performed)	Positive	Enteric infection, IBD, juvenile polyps, acid-peptic disease, foreign body, vasculitis (eg, polyarteritis nodosa); proximal small bowel disease (Crohn disease, Helicobacter pylori, peptic disease, celiac disease)
Stool calprotectin or lactoferrin	Positive	Intestinal inflammation (enteric infection, IBD, juvenile polyps, vasculitis)
IgA-tissue transglutaminase antibodies (if not already done)	Positive	Celiac disease
Complete blood count with differential	Anemia	Celiac disease, IBD
	Leukocytosis	Infection or inflammation
	Eosinophilia	Atopic disease, eosinophilic esophagitis; parasitic infection
	Thrombocytosis	Iron deficiency, ongoing inflammation
ESR/CRP	Elevated ESR or CRP	Active inflammatory process (nonspecific but may include IBD)
Metabolic panel	Elevated ALT	Hepatic inflammation (eg, chronic hepatitis)
	Elevated direct bilirubin	Cholestasis
	Elevated GGT and/or alkaline phosphatase	Common bile duct stone
	Decreased albumin	Defective liver protein synthesis, intestinal protein loss (IBD)
Lipase	Elevated	Acute pancreatitis
Urinalysis	Hematuria	Nephrolithiasis, urinary tract infection

This table is intended for use with UpToDate content on chronic abdominal pain in children. Additional laboratory evaluation may be warranted if specific organic conditions are suspected. Refer to UpToDate content for details.

ALT: alanine aminotransferase; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GGT: gamma-glutamyl transpeptidase; IBD: inflammatory bowel disease; IgA: immunoglobulin A.

Adapted from: Noe JD, Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. Pediatr Ann 2009; 38:259.

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Laboratory evaluation for children with chronic abdominal pain and alarm findings